Berner-Hansen V, Olsen AA, Brandstrup B. Endoscopic treatment of primary aorto-enteric fistulas: A case report and review of literature. World J Gastrointest Endosc 2021; 13(6): 189-197 [PMID: 34163566 DOI: 10.4253/wjge.v13.i6.189]
Corresponding Author of This Article
Victoria Berner-Hansen, MD, Doctor, Department of Surgery, Holbaek Hospital, Part of Copenhagen University Hospitals, Smedelundsgade 60, Holbaek 4300, Denmark. victoriaberner@hotmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Endosc. Jun 16, 2021; 13(6): 189-197 Published online Jun 16, 2021. doi: 10.4253/wjge.v13.i6.189
Endoscopic treatment of primary aorto-enteric fistulas: A case report and review of literature
Victoria Berner-Hansen, August A Olsen, Birgitte Brandstrup
Victoria Berner-Hansen, Birgitte Brandstrup, Department of Surgery, Holbaek Hospital, Part of Copenhagen University Hospitals, Holbaek 4300, Denmark
August A Olsen, Institute for Clinical Medicine, University of Copenhagen, Copenhagen 2200, Denmark
Birgitte Brandstrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 2200, Denmark
Author contributions: Berner-Hansen V drafted and registered the protocol, retrieved the data, analysed the data, drafted the manuscript, and approved and submitted the final manuscript; Olsen AA retrieved the data, reviewed the drafted manuscript, and approved the final manuscript; Brandstrup B conceived and designed the study, reviewed the protocol, supervised the study, reviewed the drafted manuscript, and approved the final manuscript.
Informed consent statement: Written informed consent was obtained from the patient’s next of kin (wife) for the publication of this case report and accompanying images. On request, a copy of the written content is available for review.
Conflict-of-interest statement: The authors declare no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Victoria Berner-Hansen, MD, Doctor, Department of Surgery, Holbaek Hospital, Part of Copenhagen University Hospitals, Smedelundsgade 60, Holbaek 4300, Denmark. victoriaberner@hotmail.com
Received: February 1, 2021 Peer-review started: February 1, 2021 First decision: March 1, 2021 Revised: March 12, 2021 Accepted: May 21, 2021 Article in press: May 21, 2021 Published online: June 16, 2021 Processing time: 128 Days and 21 Hours
Abstract
BACKGROUND
Primary aorto-enteric fistula (PAEF) is a rare condition, traditionally treated in the acute, bleeding phase with open surgery or endovascular repair. However, these approaches have high morbidity and mortality, indicating a need for new methods. With advances in endoscopic techniques and equipment, haemoclipping of fistulas has now become feasible. Therefore, we present a systematic review of the English literature and a rare case of a PAEF successfully treated by endoscopic haemoclipping.
CASE SUMMARY
A 74-year-old man with an abdominal aortic aneurysm presented with symptoms of haemorrhagic shock and bloody stools. An oesophago-gastro-duodenoscopy was performed with haemoclipping of a suspected PAEF in the third part of the duodenum. Afterward, a computed tomography-angiography showed a contrast filled protrusion from the abdominal aortic aneurysm. Based on the clinical presentation and the combined endoscopic and radiographic findings, we argue that this is a case of a PAEF.
CONCLUSION
Endoscopic therapy appears capable of achieving haemodynamic stabilisation in patients with bleeding PAEF, serving as a bridge to final therapy.
Core Tip: Primary aorto-enteric fistula is a rare condition with high mortality. The current acute phase treatment is surgical or endovascular and is followed by high morbidity and mortality. The aim of this systematic review and case report was to put forward endoscopic haemoclipping as a new treatment option in the acute bleeding phase of an aorto-enteric fistula and, in a systematic manner, to search the literature for any evidence behind this therapy, including other reported cases.
